Orthomolecular psychiatry is the use of orthomolecular medicine for mental illness. The approach uses unorthodox forms of individualized testing and diagnosis to attempt to establish an etiology for each patient's specific symptoms, and claims to tailor the treatment accordingly, using a combination of nutrients, dietary changes and medications that are claimed to enhance quality of life and functionality as well as to reduce or eliminate symptoms and the use of xenobiotic drugs.

Abram Hoffer in the 1950s was the first major practitioner. Hoffer's therapies focused on using niacin, among other nutrients, to treat what he diagnosed as acute schizophrenia based on an unaccepted test. In 1973, a task force of the American Psychiatric Association examined niacin monotherapy of patient populations with chronic schizophrenia and bipolar disorder and rejected the practice along with the reliability of Hoffer's diagnostic approach.[1]

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Orthomolecular psychiatry began with Abram Hoffer and Humphry Osmond in the 1950s and was continued by Carl Pfeiffer of the Pfeiffer Treatment Center,[2] although proponents of orthomolecular psychiatry say that the ideas behind their approach can be traced back to the 1920s and '30s.[3][4] Orthomolecular psychiatry's goal of weaning patients from conventional neuroleptic drugs[5] follows "Pfeiffer's Law", "For every drug that benefits a patient, there is a natural substance that can achieve the same effect".[6] In 1968, Linus Pauling used the term "orthomolecular".[7][8]

The assertions by proponents of orthomolecular psychiatry were rejected in 1973 by a panel of the American Psychiatric Association.[1][9][10] Orthomolecular psychiatry has subsequently resurged in the last ten years, however, and has found growing footing in adjunctive medical circles with the rise in conditions such as autism, heavy metal toxicity, and chronic inflammatory disease. After 1975, orthomolecular psychiatry research was primarily reported in Orthomolecular Psychiatry, now the Journal of Orthomolecular Medicine, a publication founded by Abram Hoffer to counter what he considered to be a medical conspiracy against his ideas.[11]

Proponents of orthomolecular psychiatry claim to have identified the causes of some psychiatric syndromes, in particular those that cause psychosis; according to orthomolecular proponents, testing for these causes guides diagnosis and treatment. Diagnostic measures and therapies commonly employed include "individual biochemical workup", fasting, identifying suggested allergies, dietary changes, megavitamin therapy, amino acids, and other so-called "pharmacologic nutrients".[5] These diagnoses have not been accepted by mainstream medicine.[12]

Orthomolecularists claim that the causes of psychotic disorders include food allergy, hypoglycemia, hypothyroidism in the presence of normal thyroid values, heavy metal intoxications including those allegedly due to dental fillings, as well as several hypothesised conditions they call pyroluria, histadelia and histapenia.[5] These conditions are not recognized by the conventional medical community.

Histadelia is a condition hypothesised by Carl Pfeiffer[24][25] to involve elevated serum levels of histamine and basophils,[5] which he says can be treated with methionine and vitamin B6 megadoses.[26] Pfeiffer claims that "histadelia" can cause depression with or without psychosis, but no published clinical trials have tested the effectiveness of this therapy.[27]

Orthomolecular psychiatry has been rejected by the mainstream medical community.[28] Critics have noted that the claims advanced by its proponents are unsubstantiated, and even false. Authoritative bodies such as the National Institute of Mental Health[12] and American Academy of Pediatrics[29] have criticized orthomolecular treatments as ineffective and toxic.

A 1973 task force of the American Psychiatric Association charged with investigating orthomolecular claims concluded:

This review and critique has carefully examined the literature produced by megavitamin proponents and by those who have attempted to replicate their basic and clinical work. It concludes in this regard that the credibility of the megavitamin proponents is low. Their credibility is further diminished by a consistent refusal over the past decade to perform controlled experiments and to report their new results in a scientifically acceptable fashion. Under these circumstances this Task Force considers the massive publicity which they promulgate via radio, the lay press and popular books, using catch phrases which are really misnomers like "megavitamin therapy" and "orthomolecular treatment," to be deplorable.[30]

One review suggested the APA statement was "well-intentioned" but biased, and called for further research in this field.[31]